Provider Demographics
NPI:1023508611
Name:CANTARERO, ANDREA (RDN)
Entity type:Individual
Prefix:MR
First Name:ANDREA
Middle Name:
Last Name:CANTARERO
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3217
Mailing Address - Country:US
Mailing Address - Phone:720-877-6616
Mailing Address - Fax:
Practice Address - Street 1:504 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3217
Practice Address - Country:US
Practice Address - Phone:720-877-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered